Brixadi (buprenorphine) is an extended-release injection used to treat moderate-to-severe opioid use disorder (OUD). It is usually given once a week or once a month by a health care provider.
Like many medicines, Brixadi may interact with other medicines, supplements, or alcohol.
Keep reading to learn which medicines may interact with Brixadi and what you can do to manage the risks.
This article does not include every possible interaction. Always tell your health care provider and pharmacist about everything you take, including prescription medicines, over-the-counter (OTC) products, vitamins, and supplements.
What Is a Drug Interaction?
An interaction happens when a substance changes how a medicine works or affects the body. Some interactions raise your risk of side effects, while others can make Brixadi less effective or lead to withdrawal.
Some of these interactions happen because your body breaks down buprenorphine using a liver enzyme called CYP3A4. Medicines that speed up or slow down this enzyme can change how much buprenorphine is in your body.
This is not a full list of interactions, but the following are important to know about while using Brixadi.
Benzodiazepines, alcohol, and other central nervous system depressants
Combining Brixadi with benzodiazepines, alcohol, sleep medicines, muscle relaxants, other opioids, or other medicines that slow down the central nervous system (CNS) can lead to extreme sleepiness, slowed breathing, coma, or death.
Examples include:
- Alcohol
- Benzodiazepines, such as alprazolam or diazepam
- Other sedatives, sleep medicines, or antianxiety medicines
- Gabapentin or pregabalin
- Muscle relaxants, such as cyclobenzaprine
- Other opioid medicines
Your health care provider should not automatically deny you treatment just because you take one of these medicines. Untreated opioid use disorder carries its own serious risks. Instead, they will likely want to monitor you closely. They may recommend having an opioid overdose reversal medicine on hand. Do not stop or change the dose of a benzodiazepine or other CNS depressant on your own without talking to your health care provider first.
Medicines that can raise Brixadi levels (CYP3A4 inhibitors)
Some medicines slow down how the body breaks down buprenorphine. This can increase the amount of medicine in your body and raise the risk of side effects, such as increased sedation.
Examples include:
- Azole antifungals, such as ketoconazole
- Certain HIV medicines (protease inhibitors), such as atazanavir, indinavir, and ritonavir
- Macrolide antibiotics, such as erythromycin
If you start or stop one of these medicines while on Brixadi, your health care provider will want to monitor you for signs of over-medication, such as increased sleepiness, and may need to adjust your treatment. Do not stop or change any of your medicines on your own without talking to your health care provider first.
Medicines that can make Brixadi less effective (CYP3A4 inducers)
Other medicines speed up how the body breaks down buprenorphine. This can lower the amount of medicine in your body, which may lead to withdrawal symptoms or make Brixadi less effective.
Examples include:
- Rifampin, an antibiotic
- Carbamazepine, phenobarbital, and phenytoin, medicines used for seizures
If you start one of these medicines, your health care provider will monitor you for withdrawal symptoms and may adjust your Brixadi dose or treatment plan. Tell your health care provider if you stop one of these medicines while on Brixadi, as your buprenorphine levels could rise afterward. Do not stop or change any of your medicines on your own without talking to your health care provider first.
Medicines that affect serotonin
Combining Brixadi with medicines that affect serotonin, a brain chemical, can raise the risk of a rare but serious condition called serotonin syndrome.
Examples include:
- Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs)
- Tricyclic antidepressants
- Migraine medicines called triptans
- Certain muscle relaxants, such as cyclobenzaprine
- Tramadol, an opioid pain medicine
If you take one of these medicines along with Brixadi, your health care provider will want to watch you closely for symptoms of serotonin syndrome, such as agitation, fast heartbeat, muscle twitching, sweating, or fever, especially when starting treatment or adjusting doses. Get medical help right away if you notice these symptoms.
Monoamine oxidase inhibitors
Monoamine oxidase inhibitors (MAOIs) can include certain antidepressants, medicines for Parkinson’s disease, and at least one antibiotic. They can interact seriously with opioid medicines such as Brixadi, potentially causing serotonin syndrome or other dangerous opioid-related side effects.
Examples include:
- Linezolid
- Phenelzine
- Rasagline
- Selegiline
- Tranylcypromine
Brixadi is not recommended if you are taking an MAOI or if you have stopped one within the past 14 days. Tell your health care provider about any MAOIs you have taken recently.
Diuretics (water pills)
Opioids such as buprenorphine can reduce how well diuretics work by affecting a hormone involved in fluid balance.
Examples include:
- Loop diuretics, such as bumetanide or furosemide
- Potassium-sparing diuretics, such as amiloride, spironolactone, or triamterene
- Thiazide diuretics, such as chlorthalidone, hydrochlorothiazide, or indapamide
If you take a diuretic for high blood pressure, heart failure, or fluid retention, your health care provider may monitor your blood pressure and check whether your diuretic is working as expected.
Anticholinergic medicines
Certain medicines used for conditions such as overactive bladder, allergies, or some psychiatric conditions have anticholinergic effects. Combining these with Brixadi may raise your risk of severe constipation or trouble urinating.
Examples include:
- Overactive bladder medicines, such as oxybutynin or tolterodine
- Allergy medicines such as chlorpheniramine, diphenhydramine, or hydroxyzine
- Tricyclic antidepressants, such as amitriptyline, doxepin, or nortriptyline
Tell your health care provider about any anticholinergic medicines you use so they can monitor you for these effects.
FAQs: Brixadi Interactions
Does Brixadi interact with alcohol?
Yes. Drinking alcohol while using Brixadi can lead to extreme drowsiness, slowed breathing, loss of consciousness, or death. Avoid alcohol while you are being treated with Brixadi.
Does Brixadi interact with supplements?
Some herbal supplements can affect the CYP3A4 enzyme that breaks down buprenorphine, which could change how much Brixadi is in your body. St. John’s wort, sometimes used for depression, is one example of a supplement that can speed up this enzyme. Always tell your health care provider about any supplements you take before starting Brixadi.
What should I avoid while using Brixadi?
Avoid alcohol, and do not take benzodiazepines, sleep aids, or other central nervous system depressants unless your health care provider knows about it and is monitoring you. Do not drive or operate machinery until you know how Brixadi affects you, especially in the first few days after a dose or dose change.
Reducing Your Risk of Interactions
Helpful tips include:
- Tell your health care provider and pharmacist about every prescription medicine, OTC medicine, and any vitamins, herbs, or other supplements you use.
- Ask your health care provider before starting or stopping any medicine, vitamin, or supplement.
- Keep all recommended lab tests and monitoring appointments.
- Ask about having an opioid overdose reversal medicine on hand, and make sure people close to you know how to use it.
- Report any new or worsening symptoms to your health care provider right away.
Your health care provider can review your treatment plan and make adjustments as needed to help make sure Brixadi is safe for you. Do not change or stop treatment on your own.
